Common use of READINESS REVIEW AND ANNUAL REQUIREMENTS FOR REVIEW Clause in Contracts

READINESS REVIEW AND ANNUAL REQUIREMENTS FOR REVIEW. Prior to the execution of this contract, and annually thereafter the Department and/or its duly authorized representative will conduct comprehensive readiness review(s) which will include a minimum of one site visit. This review may be conducted prior to enrollment of any members in the MCO, prior to the renewal of the Contract, prior to the Contract being amended to add newly covered populations or aid categories, and anytime thereafter upon the Department’s request and at the Department’s discretion. The purpose of the review is to provide the Department with assurances that the MCO is able and prepared to perform all administrative functions and to provide high-quality services to enrolled members. The review will document the status of the MCO with respect to meeting program standards set forth in the BBA, federal regulations, and this Contract, as well as any goals established by the Department. During the Readiness Review, the Department may make a determination that the Contractor is not able to perform any or all of its obligations under this Contract. The Department reserves the right to deny participation in some or all areas of the Commonwealth for the Medallion 4.0 program if the Contractor fails the Readiness Review within the timeframe specified. The readiness review activities will be conducted by the Department’s External Quality Review Organization (EQRO), and/or by a multidisciplinary team appointed by the Department. The scope of the readiness review(s) will include, but not be limited to; review and/or verification of: network provider composition and access; staffing; content of provider agreements; policies and procedures consistent with the Medallion 4.0 contractual standards; pregnancy and complex care management programs; EPSDT plan; CYSHCN plan; financial solvency; and information systems performance and interfacing capabilities. The Contractor agrees to meet any expansion criteria as may be required by the Department. The readiness review(s) will assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. In the instance where there is a change to the contract terms that does not affect one or more of the elements above, and when the Department has previously conducted a readiness review on the non-impacted element(s), the Department has the discretion to deem that the previously conducted readiness review for non-impacted items is sufficient to meet readiness requirements. The Department will provide the Contractor with a summary of the findings, as well as areas requiring remedial action. No individual shall be enrolled into the Contractor’s health plan prior to the Department making an initial determination that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.

READINESS REVIEW AND ANNUAL REQUIREMENTS FOR REVIEW. ‌ Prior to the execution of this contract, and annually thereafter the Department and/or its duly authorized representative will conduct comprehensive readiness review(s) which will include a minimum of one site visit. This review may be conducted prior to enrollment of any members in the MCO, prior to the renewal of the Contract, prior to the Contract being amended to add newly covered populations or aid categories, and anytime thereafter upon the Department’s request and at the Department’s discretion. The purpose of the review is to provide the Department with assurances that the MCO is able and prepared to perform all administrative functions and to provide high-high- quality services to enrolled members. The review will document the status of the MCO with respect to meeting program standards set forth in the BBA, federal regulations, and this Contract, as well as any goals established by the Department. During the Readiness Review, the Department may make a determination that the Contractor is not able to perform any or all of its obligations under this Contract. The Department reserves the right to deny participation in some or all areas of the Commonwealth for the Medallion 4.0 program if the Contractor fails the Readiness Review within the timeframe specified. The readiness review activities will be conducted by the Department’s External Quality Review Organization (EQRO), and/or by a multidisciplinary team appointed by the Department. The scope of the readiness review(s) will include, but not be limited to; review and/or verification of: network provider composition and access; staffing; content of provider agreements; policies and procedures consistent with the Medallion 4.0 contractual standards; pregnancy and complex care management programs; EPSDT plan; CYSHCN plan; financial solvency; and information systems performance and interfacing capabilities. The Contractor agrees to meet any expansion criteria as may be required by the Department. The readiness review(s) will assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. In the instance where there is a change to the contract terms that does not affect one or more of the elements above, and when the Department has previously conducted a readiness review on the non-impacted element(s), the Department has the discretion to deem that the previously conducted readiness review for non-impacted items is sufficient to meet readiness requirements. The Department will provide the Contractor with a summary of the findings, as well as areas requiring remedial action. No individual shall be enrolled into the Contractor’s health plan prior to the Department making an initial determination that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.

READINESS REVIEW AND ANNUAL REQUIREMENTS FOR REVIEW. Prior to the execution of this contract, and annually thereafter the Department and/or its duly authorized representative will conduct comprehensive readiness review(s) which will include a minimum of one site visit. This review may be conducted prior to enrollment of any members in the MCO, prior to the renewal of the Contract, prior to the Contract being amended to add newly a new covered populations population or any new aid categories, and anytime thereafter upon the Department’s request and at the Department’s discretion. The purpose of the review is to provide the Department with assurances that the MCO is able and prepared to perform all administrative functions and to provide high-quality services to enrolled members. The review will document the status of the MCO with respect to meeting program standards set forth in the BBA, federal regulations, and this Contract, as well as any goals established by the Department. During the Readiness Review, the Department may make a determination that the Contractor is not able to perform any or all of its obligations under this Contract. The Department reserves the right to deny participation in some or all areas of the Commonwealth for the Medallion 4.0 program if the Contractor fails the Readiness Review within the timeframe specified. The readiness review activities will be conducted by the Department’s External Quality Review Organization (EQRO), and/or by a multidisciplinary team appointed by the Department. The scope of the readiness review(s) will include, but not be limited to; review and/or verification of: network provider composition and access; staffing; content of provider agreements; policies and procedures consistent with the Medallion 4.0 contractual standards; pregnancy and complex care management programs; EPSDT plan; CYSHCN plan; financial solvency; and information systems performance and interfacing capabilities. The In the event of Medicaid Expansion, the Contractor agrees must agree to meet any expansion criteria as may be required by the Department. The readiness review(s) will assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. In the instance where there is a change to the contract terms that does not affect one or more of the elements above, and when the Department has previously conducted a readiness review on the non-impacted element(s), the Department has the discretion to deem that the previously conducted readiness review for non-impacted items is sufficient to meet readiness requirements. The Department will provide the Contractor with a summary of the findings, as well as areas requiring remedial action. No individual shall be enrolled into the Contractor’s health plan prior to the Department making an initial determination that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.

READINESS REVIEW AND ANNUAL REQUIREMENTS FOR REVIEW. Prior to the execution of this contract, and annually thereafter the Department and/or its duly authorized representative will conduct comprehensive readiness review(s) which will include a minimum of one site visit. This review may be conducted prior to enrollment of any members in the MCO, prior to the renewal of the Contract, prior to the Contract being amended to add newly covered populations or aid categories, and anytime thereafter upon the Department’s request and at the Department’s discretion. request.. The purpose of the review is to provide the Department with assurances that the MCO is able and prepared to perform all administrative functions and to provide high-quality services to enrolled members. The review will document the status of the MCO with respect to meeting program standards set forth in the BBA, federal regulations, and this Contract, as well as any goals established by the Department. During the Readiness Review, the Department may make a determination that the Contractor is not able to perform any or all of its obligations under this Contract. The Department reserves the right to deny participation in some or all areas of the Commonwealth for the Medallion 4.0 program if the Contractor fails the Readiness Review within the timeframe specified. The readiness review activities will be conducted by the Department’s External Quality Review Organization (EQRO), and/or by a multidisciplinary team appointed by the Department. The scope of the readiness review(s) will include, but not be limited to; review and/or verification of: network provider composition and access; staffing; content of provider agreements; policies and procedures consistent with the Medallion 4.0 contractual standards; pregnancy and complex care management programs; EPSDT plan; CYSHCN plan; financial solvency; and information systems performance and interfacing capabilities. The In the event of Medicaid Expansion, the Contractor agrees must agree to meet any expansion criteria as may be required by the Department. The readiness review(s) will assess the Contractor’s ability to meet any requirements set forth in this Contract and the documents referenced herein. In the instance where there is a change to the contract terms that does not affect one or more of the elements above, and when the Department has previously conducted a readiness review on the non-impacted element(s), the Department has the discretion to deem that the previously conducted readiness review for non-impacted items is sufficient to meet readiness requirements. The Department will provide the Contractor with a summary of the findings, as well as areas requiring remedial action. No individual shall be enrolled into the Contractor’s health plan prior to the Department making an initial determination that the Contractor is ready and able to perform its obligations under the Contract as demonstrated during the Readiness Review.